What we’ve said about Lamotrigine

“So it does help prevent the episodes of mania. But if a patient's manic or hypomanic, it's not going to work. So the best way to think of it, all these medications typically is you're preventing episodes more so than stopping them”

“its anti-manic efficacy is not fantastic, but its relatively robust antidepressant effect for bipolar depression, pretty great. I know the studies show that it's not effective for treating acute depression. I'm going to say my clinical experience contradicts that”

“I'm a big glomotrigine and low-dose lithium fan. I think we talked about those some in our labs go around. And if people find it useful, more detail on how to do simplified social rhythm therapy”

“simplified social rhythm therapy is my number one mood stabilizer and then lamotrigine and low-dose lithium”

“Which are the MSAEs? This I thought was where you were going with the Ls. Three Ls and a Q for the mood stabilizers with antidepressant efficacy. I missed trazodone. Lithium, lamotrigine, trazodone, and we have to put quetiapine on there”

“just don't forget to consider things like lamotrigine, lithium to add on rather than choosing the second antipsychotic. If you have to choose the second antipsychotic, please pick one that actually is appreciably different than the one you're already using”

“you don't use something that's not indicated just because the side effect profile matches the side effect profile that you want. For patients with emotional dysregulation and reporting depression, I do see it helpful. I don't see it helpful in MDD proper”

“You should absolutely follow the rules. Do not titrate. You'll see a slower titration schedule depending on whether you're dosing the same time as an inhibitor of its metabolism, like Depakote, for example, or with other considerations. But follow that protocol and warn, warn, warn”

“Don't linger on lower doses, in my opinion. If you're going to use it, get it to 200. It's so well tolerated, okay, and you get benefit. But also, don't be afraid to go above 200 either. You can technically go to 400”

“valproic acid jacks up the levels of lamotrigine. So the way I remember it is when you combine those two medications, it's the dangerous interaction. So increasing lamotrigine is what we're scared of because of SJS. So whenever you're interacting using those medications, you should half the lamotrigine”

“They have no side effects or long-term risks. This is like almost nothing. Lamotrigine gets close, but otherwise it's almost nothing”

“We're talking about a rash that is new and that you haven't had before and that's different. If you get any new rash while we're starting this medication, I want you to stop the medication and go to the ER. That's how I do it”

“don't be like, you know, the rash isn't that big a deal. Like, why don't you, like, you have to still give the proper responses, even if the system behind you is not built to appropriately respond to it”

“I think of it very much in the way that we talked about low-dose lithium in terms of how to manage it. Don't let people have side effects. That'll blow the ballgame”

“pregnancy will reduce the serum levels of lamotrigine by about half. I believe it's estrogen that does this”

“Lamotrigine. which is the weakest, but also probably the best tolerated. We have lithium, which is the gold standard, the classic. And we have Depakote. Works great. There are some problems with it, especially with both male and female fertility”

“A lot of people can get away with having a lower daily dose of lithium if they're on their 200 of lamotrigine. And then it'll be much more tolerable than trying to do just the lithium, for example”

“Is it probably less efficacious than Depakote, Lamotrigine, and Lithium? Probably. But I also think that at higher doses, it may actually be more efficacious than Lamotrigine. If it's the right patient, it's actually not that bad”

“is it actually better in the long run than let's say lithium plus lamotrigine? I don't think so. But, you know, they don't study that kind of thing head to head”

“get rid of something first so that Lamotrigine gets a fairer trial. In particular, antidepressants. Patients who are already on an antidepressant makes it less likely that lamotrigine will demonstrate its remarkable capacities”

“sometimes I worry that medications without side effects like lamotrigine and bupropion, people will keep patients on and then not offer what the correct treatment is”

“I'm definitely against that, personally speaking. I know some people are believers in that, and there's this tiny little signal from that old UK study. But I don't really believe in that”